Pathology - Vulva Flashcards

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1
Q

What is the vulva defined as?

A

Area external to the hymen

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2
Q

What is a Bartholin cyst?

A
  • Blockage of Bartholin gland causing accumulation of gland fluid
  • Unilateral, painful cystic lesion
  • Lower vestibule adjacent to vaginal canal
  • Occurs in women of reproductive age
  • Associated with infection
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3
Q

What is the colloquial name for condylomas?

A

Genital warts

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4
Q

Describe a condyloma

A
  • Watery neoplasm of vulvar skin, often large
  • Characterized by koilocytic change
  • Rarely progresses to carcinoma
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5
Q

What are condylomas commonly due to?

A

HPV 6 or 11 (low risk for carcinoma)

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6
Q

What are the high risk strains of HPV?

A

16, 18 (mostly); 31, 33 (also)

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7
Q

What does a condyloma look like on histology?

A

Raisin-like appearance of nucleus

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8
Q

What is lichen sclerosis?

A
  • Thinning of epidermis and fibrosis of dermis
  • Leukoplakia (white patch) with parchment-like vulvar skin
  • Benign - slight increased risk of sq cell carcinoma
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9
Q

Who is affected by lichen sclerosis?

A

Postmenopausal women

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10
Q

What is lichen simplex chronicus?

A
  • Hyperplasia of vulvar sq epithelium
  • leukoplakia w. thick, leathery vulvar skin
  • Benign (no incr risk of SCC)
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11
Q

What can lichen simplex chronicus be due to?

A
  • Chronic irritation / scratching

- Postmenopausal women

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12
Q

What does vulvar carcinoma present with?

A

Leukoplakia

- Biopsy required to distinguish from other causes

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13
Q

What are the 2 pathways associated with vulvar carcinoma?

A
  • HPV related (younger 40-50) arises from vulvar intraepithelial neoplasia
  • Non-HPV-> lichen sclerosis (older women >70) arises from chronic irritation
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14
Q

What is extramammary paget disease?

A

Malignant epithelial cell in the epidermis of the vulva

  • Presents as erythematous, pruritic, ulcerated skin
  • Carcinoma in situ - usually no underlying carcinoma
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15
Q

What is the differential diagnosis of extramammary Paget disease?

A

Melanoma

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16
Q

What are the differences between Paget cells and melanoma

A

Paget cells: PAS +, keratin + and S100-

Melanoma: PAS -, keratin - and S100+

17
Q

What does PAS + indicate?

A

Mucus secreting

18
Q

What does keratin + indicate?

A

Epithelial tissue (usually)

19
Q

What is imperforate hymen?

A
  • Incomplete degeneration of the central portion of the hymen
  • Accumulation of vaginal mucus at birth -> self-resolving buldge in introitus
20
Q

What does imperforate hymen present with?

A
  • Primary amenorrhea
  • Cyclic abdominal pain
  • Hematocolpos (accumulation of menstrual blood in vagina)
  • Buldging bluish hymenal membrane